An orthopaedic overview Spine exam An orthopaedic overview

Outline Review anatomy General exam reminder Four conditions to illustrate the exam including overview of provocative testing

Cervical spine

Lumbar spine

Supporting ligaments

Muscles

Nerves: Spinal cord

Spinal cord injury

Brachial plexus

Sacral plexus

General exam reminder Look Feel Move Provocative/special testing Kyphosis, lordosis, alignment Gait and posture Feel Tenderness, swelling, neurodeficits Move Active and passive ROM Provocative/special testing

Look: Symmetry, Alignment, Contour, Skin, Swelling, Bruising

Curves of spine

Palpate

Landmarks Hyoid, thyroid cartilage, SCM, thyroid, carotid, LNs

Landmarks Occiput, spinous processes, facet joints, traps

Landmarks

Landmarks Iliac crest, posterior iliac spine, SI joints, greater trochanter, ischial tuberosity, spinous processes

Finger to floor distance

Lateral flexion Normal 25º or measure

Spine rotation Normal 30º

Extension Combined segments, look for more than 5 degrees from vertical

Schöber maneuver

Cervical spine ROM (*standing) The results showed that the most reliable protocol for assessment of neck ROM is a passive measurement in the standing position. Cervical spine ROM measurements: optimizing the testing protocol by using a 3D ultrasound-based motion analysis system. 2005 Dec;25(12):1133-45. Cephalalgia 80 degree rotation, 60 degree flexion (chest), 70 degree extension and 45 degree lateral bend

Chest expansion Normal 4 to 7 cm based on gender and age

LS Nerve root testing Slump test SLR Lasegue Bowstring Bragard

Slump test

Lasegue sign SLR Straight Leg Raising Test. Sciatic Nerve Tension at 30-60° of Hip Flexion. Dorsiflexion of Ankle May Produce Lasegue's Sign.

Bowstring

Bragard test

Function testing: Nerve root T12 to L3 T12-L3 hip flexion – iliopsoas L2-L4 knee extension – quads L4 – tibialis anterior –dorsiflexion with inversion L5 – heel walk S1 – toe walk

Dermatomes

DTRs

Function testing: Nerve root C5 radiculopathy Weakness: shoulder abduction C6 radiculopathy Weakness: elbow flexion, wrist extension C7 radiculopathy Weakness: elbow extension, wrist flexion C8 radiculopathy Weakness: finger extension T1 radiculopathy Weakness: intrinsic muscles of hand

Compression test

Distraction test

Let’s practice